The economic and health burden of out-of-pocket health payments is a particular concern for households in
developing and transitional countries and can heighten the risk of insuperable hardships due to poverty and
illness. Anita Wagner, Dennis Ross-Degnan, Sheila Reiss, and Amy Johnson are conducting research on the role
of medicines in catastrophic health spending and focusing their attention on the relationship between health
insurance and medicine affordability and access.

Using 2002 World Health Survey data, they examined basic household demographic characteristics,
health expenditures, and medicine access among respondents in eight low and middle-income countries. The
survey is available here.
Findings from these preliminary descriptive analyses revealed a significant
prevalence of poverty and out-of-pocket medicine spending among households. Individual respondents commonly
reported cost as a barrier to access to medicines.

The second phase of this research is now underway and will involve analytic work to assess the key
determinants of medicine access and affordability. The research team will estimate the extent to which
health insurance protects households from catastrophic health expenditures, as well as the impact of insurance
on cost-related barriers to medicine access. The team also seeks to examine the correlates of unmet medicine
need among individuals who are chronically ill. This research will inform the design of future household
surveys and medicines policies developed under the aegis of the Medicines Transparency Alliance (MeTA), an
initiative of the U.K. Department for International Development. This work is conducted in collaboration
with colleagues from the WHO Medicines Policy and Standards and Measurement and Health Information Systems
programs and is funded by DfID.